Form CEM-4902D "Extra Work Bill - Material Charges" - California

What Is Form CEM-4902D?

This is a legal form that was released by the California Department of Transportation - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 1994;
  • The latest edition provided by the California Department of Transportation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CEM-4902D by clicking the link below or browse more documents and templates provided by the California Department of Transportation.

ADVERTISEMENT
ADVERTISEMENT

Download Form CEM-4902D "Extra Work Bill - Material Charges" - California

1332 times
Rate (4.4 / 5) 67 votes
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
CASEWB
EXTRA WORK BILL - MATERIAL CHARGES
CEM-4902D (NEW 7/1994)
Front CT# 7541-3499-3
CONTRACT NO.
CCO NO.
REPORT NO.
PAGE
MATERIAL and/or WORK done by specialist
of
or LUMP SUM or UNIT PRICE PAYMENTS
VENDOR NAME
INVOICE NUMBER
MO
DAY
YR
24
INVOICE DESCRIPTION
UNITS
UNIT COST OR NET PAY
EXTENDED TOTAL
VENDOR NAME
INVOICE NUMBER
MO
DAY
YR
25
INVOICE DESCRIPTION
UNITS
UNIT COST OR NET PAY
EXTENDED TOTAL
VENDOR NAME
INVOICE NUMBER
MO
DAY
YR
26
INVOICE DESCRIPTION
UNITS
UNIT COST OR NET PAY
EXTENDED TOTAL
VENDOR NAME
INVOICE NUMBER
MO
DAY
YR
27
INVOICE DESCRIPTION
UNITS
UNIT COST OR NET PAY
EXTENDED TOTAL
VENDOR NAME
INVOICE NUMBER
MO
DAY
YR
28
INVOICE DESCRIPTION
UNITS
UNIT COST OR NET PAY
EXTENDED TOTAL
VENDOR NAME
INVOICE NUMBER
MO
DAY
YR
29
INVOICE DESCRIPTION
UNITS
UNIT COST OR NET PAY
EXTENDED TOTAL
VENDOR NAME
INVOICE NUMBER
MO
DAY
YR
30
INVOICE DESCRIPTION
UNITS
UNIT COST OR NET PAY
EXTENDED TOTAL
VENDOR NAME
INVOICE NUMBER
MO
DAY
YR
31
INVOICE DESCRIPTION
UNITS
UNIT COST OR NET PAY
EXTENDED TOTAL
VENDOR NAME
INVOICE NUMBER
MO
DAY
YR
32
INVOICE DESCRIPTION
UNITS
UNIT COST OR NET PAY
EXTENDED TOTAL
VENDOR NAME
INVOICE NUMBER
MO
DAY
YR
33
INVOICE DESCRIPTION
UNITS
UNIT COST OR NET PAY
EXTENDED TOTAL
SIGNATURE OF RESIDENT ENGINEER
SIGNATURE OF PRIME CONTRACTOR'S REPRESENTATIVE
INVOICE
TOTAL (B)
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
CASEWB
EXTRA WORK BILL - MATERIAL CHARGES
CEM-4902D (NEW 7/1994)
Front CT# 7541-3499-3
CONTRACT NO.
CCO NO.
REPORT NO.
PAGE
MATERIAL and/or WORK done by specialist
of
or LUMP SUM or UNIT PRICE PAYMENTS
VENDOR NAME
INVOICE NUMBER
MO
DAY
YR
24
INVOICE DESCRIPTION
UNITS
UNIT COST OR NET PAY
EXTENDED TOTAL
VENDOR NAME
INVOICE NUMBER
MO
DAY
YR
25
INVOICE DESCRIPTION
UNITS
UNIT COST OR NET PAY
EXTENDED TOTAL
VENDOR NAME
INVOICE NUMBER
MO
DAY
YR
26
INVOICE DESCRIPTION
UNITS
UNIT COST OR NET PAY
EXTENDED TOTAL
VENDOR NAME
INVOICE NUMBER
MO
DAY
YR
27
INVOICE DESCRIPTION
UNITS
UNIT COST OR NET PAY
EXTENDED TOTAL
VENDOR NAME
INVOICE NUMBER
MO
DAY
YR
28
INVOICE DESCRIPTION
UNITS
UNIT COST OR NET PAY
EXTENDED TOTAL
VENDOR NAME
INVOICE NUMBER
MO
DAY
YR
29
INVOICE DESCRIPTION
UNITS
UNIT COST OR NET PAY
EXTENDED TOTAL
VENDOR NAME
INVOICE NUMBER
MO
DAY
YR
30
INVOICE DESCRIPTION
UNITS
UNIT COST OR NET PAY
EXTENDED TOTAL
VENDOR NAME
INVOICE NUMBER
MO
DAY
YR
31
INVOICE DESCRIPTION
UNITS
UNIT COST OR NET PAY
EXTENDED TOTAL
VENDOR NAME
INVOICE NUMBER
MO
DAY
YR
32
INVOICE DESCRIPTION
UNITS
UNIT COST OR NET PAY
EXTENDED TOTAL
VENDOR NAME
INVOICE NUMBER
MO
DAY
YR
33
INVOICE DESCRIPTION
UNITS
UNIT COST OR NET PAY
EXTENDED TOTAL
SIGNATURE OF RESIDENT ENGINEER
SIGNATURE OF PRIME CONTRACTOR'S REPRESENTATIVE
INVOICE
TOTAL (B)
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
ADA Notice
EXTRA WORK BILL - MATERIAL CHARGES
For individuals with sensory disabilities, this document is available in alternate
CEM-4902D (NEW 7/1994)
Back CT# 7541-3499-3
formats.
For information call (916) 654-6410 or TDD (916) 654-3880 or write
Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
Preparing Form CEM-4902D
Form CEM 4902D is provided for entry of the contractor material and/or work done by specialist or LUMP SUM or UNIT PRICE
PAYMENTS. It is not practical to use the Extra Work Bill to compute invoices, due to tax and discount; the net amount of the invoice
should be entered as a unit. Information in the shaded area will not become part of the electronic copy of the bill. Following is a list of
these fields:
FIELD
REMARKS
Contract No.
Required entry, same as on the Title Page
CCO Number
Required entry, same as on the Title Page
Report No.
Required entry, same as on the Title Page
Vendor Name
Optional entry.
Invoice Number
Optional entry.
Invoice Date
Optional entry. "VAR" is an acceptable invoice date entry.
Invoice Description
Optional entry.
Units
Required entry. Both lump-sum and unit-price entries require a unit to be input.
Unit Cost or Net Pay
Required entry.
NOTE: The Material entry will not be processed unless there is a value in both the Unit and the Unit Cost fields.
Page of 2